Sunday, March 14, 2010

Why Shouldn't Specialist Nurses Be Paid More Than Family Doctors?

Recently I encountered the following headline on the web: “Specialist nurses paid higher salaries than family doctors.” Knowing that my students graduate to become the highest paid members of the nursing profession, I suspected that the “specialist nurses” were CRNAs (Certified Registered Nurse Anesthetists). Yes, I was right – the article is referring to CRNAs. But this article is misleading and reflects a bias that is crying out for comment. Here is the article followed by my thoughts.

Specialist nurses paid higher salaries than family doctors
Parija Kavilanz, senior writer, On Thursday March 11, 2010, 2:32 pm EST

Despite the growing shortage of family doctors in the United States, medical centers last year offered higher salaries and incentives to specialist nurses than to primary care doctors, according to an annual survey of physicians' salaries.

Primary care doctors were offered an average base salary of $173,000 in 2009 compared to an average base salary of $189,000 offered to certified nurse anesthetists, or CRNAs, according to the latest numbers from Merritt Hawkins & Associates, a physician recruiting and consulting firm.

And the firm's projections for 2010 indicate that the average base salary for family physicians will be about $178,000 compared to $186,000 for CRNAs.

CRNAs are advanced practice nurses who administer anesthesia to patients. An important distinction between CRNAs and anesthesiologist is that when anesthesia is administered by a nurse anesthetist, it is still recognized as the practice of nursing rather than a practice of medicine

"It's the fourth year in a row that CRNAs were recruited at a higher pay than a family doctor," said Kurt Mosley, staffing expert with Merritt Hawkins & Associates.

CRNA salaries have trended higher as the number of surgical procedures picked up pace over the past few years, fueling demand for anesthesiologists and anesthetists.

Mosley said medical doctors and specialists, including anesthesiologists, typically have four to five years more of medical training than CRNAs. After spending a lot of time speaking with physicians around the country, he said many family doctors are starting to feel like "second-class citizens."

This type of income disparity "won't make them feel better," he said. Most primary care doctors say they're already struggling to make ends meet as their costs rise faster than what Medicare and private insurers are paying them .

Looking at these compensation trends, the biggest concern for the nation's health care system is how to encourage more medical students to pick primary care as their specialty at a time when the nation is already facing a shortage of about 60,000 primary care doctors.

"The demand for primary care doctors will increase twofold when health reform happens and millions of more Americans have access to health care," said Mosley. "Who is going to triage these patients? It's not the neurologist or pulmonologist. It has to be the primary care doctor."

The American Association of Nurse Anesthetists (AANA) maintains that CRNAs are being fairly compensated.

"From our perspective, we are fairly compensated for the level of responsibility that we shoulder," said Lisa Thiemann, senior director of professional services with the AANA.

"We are at the head of the patient's bed. We deliver anesthesia and we keep the patient safe," said Thiemann, who has been a CRNA for 14 years.

"Once nurses and physicians arrive at anesthesia training, we use the same textbooks and same cases. The training is not too different between the two groups," she said. "We all deliver anesthesia the same way."

Copyright © 2010 Cable News Network and Time Inc. and their affiliated companies. All Rights Reserved.
How dare any nurses make more money than any doctors! Take note that apples are being compared with oranges, because the services provided by primary care physicians versus anesthetists are vastly different. Logically the salary of nurse anesthetists should be compared with that of anesthesiologists because both groups provide basically the same services. Likewise, the salary of primary care physicians (also called family doctors) should be compared with that of nurse practitioners who provide basically the same services. I “Googled” the missing 2009 average base salaries to make the comparisons shown below.

2009 Average Base Salaries

Anesthesiologist  $317,000
Nurse Anesthetist  $186,000

Primary Care Physician $173,000
Nurse Practitioner  $83,000

Note that nurse anesthetists are more cost effective than anesthesiologists, and nurse practitioners cost less than primary care physicians.
Nurses are upgrading their knowledge and skills and filling an increasing need. In many rural areas, nurse anesthetists are the sole providers of anesthesia. And as an instructor who continues to teach physiology and related sciences to future nurse anesthetists for the thirty-seventh year, I can tell you that the textbooks are the same as those in medical school. The same mountaintop is reached despite the somewhat different paths taken.
Maybe doctors think they should always make more money than any and all nurses and that nurses should always be subservient to them. But doctors and nurses are healthcare professionals in their own right, and it’s in the best interest of the patients that they compete in the market place like everyone else. Maybe the public should be asking whether the big discrepancy in remuneration to specialist MDs versus specialist RNs for the same work is warranted?

Certified Registered Nurse Anesthetist (CRNA)
For many, the nurse practitioner is The Doctor


  1. Yay!! Great Comment Ronnie!! You were instrumental in my training in anesthesia school. Thanks for all your help and your continued support! Tammy Willman,CRNA,MS

  2. Dr. Drantz

    As a Nurse Anesthetist I thank you for this post. The propagandized political onslaught we get from other groups can get frustrating and old. It is really refreshing to see someone who has no 'horse in the race' tell it like it is.

    Thanks again.

  3. CRNA's who have entered the profession recently have no recollection of when CRNA's were paid at a rate that was insulting as compared to their responsibilities. I became a CRNA in 1979. My first job was at a general hospital that performed all procedures from open heart surgery to neuro-surgery and all other specialities. My base salary was $17,100 per year for an average work week of 45 hours and at times up to 50 hours per week, no overtime pay.

    That computes to an hourly compensation of approximately $7.30 per hour. Many of the OR nurses were earning more than myself and other CRNA's in the anesthesia department.

    All CRNA's worked independently with little time even for lunch or a break.

    All I can say is, fair is fair. For years CRNA's were grossly underpaid, worked till practically exhausted and under appreciated for their contribution to the care of patients. CRNA's provided care with excellent outcomes and still do. This is due to the fact that a CRNA must practice to a more "demanding standard" than their physician colleagues because if an unsatisfactory outcome occurs they will be looked upon as a "surrogate" provider with lesser qualifications than a physician.

    CRNA's are finally paid at a level that is commensurate with the high level of responsibility they have and the extreme pressure under which they work in the modern day operating room atmosphere.

    Kenneth R Castle, CRNA

  4. One aspect of the health care reform debate that hasn't been discussed much is how increasing the ranks of the insured will place increased demand on the health care industry, which is already experiencing worker shortages. Julian Alssid with the Workforce Strategy Center has an interesting article in Huffington Post about the issue...

  5. This is Hannah Bevills, I am an editor with We are a medical publication whose focus is geared towards promoting awareness on hospitals, including information, news, and reviews on them. Given the relevance of what you are offering from your site and what our mission is, I feel we may be able to collaborate in some way or another, I look forward to your response regarding the matter. Thanks!

    Hannah Bevills

  6. Ronnie,

    You are a total douchebag. You are a disservice to your specialty. Maybe you think that omitting several years of journeyman training or having to prove yourself in front of rigorous medical boards which are harder than nursing certificates is nothing. Maybe you think that a first year nurse anesthetist is ready to practice independently. I guess years of training to learn pathology and pharmacology and the diagnosis and treatment of such diseases is nothing.

    You are a complete fucking fool. I hope you are paid $40,000 which is what you are promoting for physicians. I hope you never get medical treatment or surgery from a medical doctor ever again because you are completely undercutting them.

  7. I was pleasantly surprised on nurse anesthetist programs day with excellent presenters and great food. I will be attending more of you anesthesia conferences in the near future.

  8. My ex-boyfriend is now a travel nurse. He studied long and hard, and while I'm no judge on how much he should be paid, I certainly couldn't get paid enough to change an adult's bedpan! Thanks to all the nurses out there who literally do the "dirty work!"